A sicker population

Although extending benefits to ex-offenders may not be the most popular aspect of the ACA, the expansion to ex-cons is seen as significant because this population is generally in worse health than the overall population. They have higher rates of chronic and infectious disease (in particular, asthma, hypertension, tuberculosis, diabetes, hepatitis and HIV/AIDS), addiction and mental illness. Those ailments and the lack of treatment on the outside contribute to the high mortality rate among former prisoners noted in a 2007 study published in The New England Journal of Medicine.

The study found that in the first two weeks after release, the rate of death among former inmates was more than 12 times greater than the rate for the general public. The leading causes of death for the ex-cons were drug overdose and car-diovascular disease.

Health insurance coverage for ex-prisoners by way of Medicaid should help reduce high mortality, researchers say. Given the high rate of addiction and mental illness among ex-prisoners, another vital law that helps them is the federal Mental Health and Addiction Equity Act, which requires health insurers to provide benefits for mental health and substance treatment that are on par with those they offer for medical and surgical services.

The corrections system is obligated to provide prisoners with health care, both physical and mental. New prisoners usually receive health screenings early in confinement. Although the quality of treatment varies across states, prison affords the best health care for many inmates that they’ve received in their lives.

Many of the 650,000 prisoners released next year will be eligible for Medicaid. To ensure continuity of care, researchers and advocates are urging states to help these prisoners enroll in Medicaid and link them to health care providers before they walk through the prison gates.

“When people are on their own, the likelihood of them taking that first step is not high,” said Paul Samuels, president of the Legal Action Center, which advocates for those with histories of addiction, HIV/AIDS or criminal records. “Their lives are very disordered. Many don’t have an ID, so enrolling in programs can be very difficult.”

New York, Oklahoma, Florida, Illinois and California are among the states that already have pre-release programs aimed at connecting at least some outgoing prisoners with Medicaid. Some states, including New York, are also investigating ways of connecting ex-prisoners with full-service medical homes that coordinate health care services to manage patients’ care.